Impact of de-escalation therapy on clinical outcomes for intensive care unit-acquired pneumonia.
Crit Care. 2011 Mar 2;15(2):R79
Authors: Joung MK, Lee JA, Moon SY, Cheong HS, Joo EJ, Ha YE, Sohn KM, Chung SM, Suh GY, Chung DR, Song JH, Peck KR
ABSTRACT: INTRODUCTION: De-escalation therapy is a strategy currently used for the management of nosocomial pneumonia. This study evaluated clinical outcomes and risk factors related to de-escalation therapy in patients with intensive care unit (ICU)-acquired pneumonia. METHODS: This was a retrospective observational cohort study of ICU patients that developed pneumonia more than 48 h after admission to the ICU at Samsung Medical Center from September 2004 to December 2007. RESULTS: The 137 patients comprised 44 who received de-escalation therapy (32.1%) and 93 in the non-de-escalation group. The de-escalation group showed a lower pneumonia-related mortality rate by day 14 (2.3% vs. 10.8%, respectively; P=0.08) and day 30 (2.3% vs. 14%, respectively; P=0.03) after the diagnosis of pneumonia, compared to the non-de-escalation group. The variables independently associated with ICU-acquired pneumonia related mortality included the Acute Physiology and Chronic Health Evaluation (APACHE II) score and the modified clinical pulmonary infection score (CPIS) after 5 days with pneumonia. The non-de-escalation group had a significantly higher APACHE II score and the modified CPIS after 5 days with ICU-acquired pneumonia compared to the de-escalation group. Among all patients, 20.4% (28/137) had negative cultures for pathogens and 42.9% (12/28) received de-escalation therapy. The latter 12 patients received de-escalation therapy and survived 30 days after the diagnosis of pneumonia. CONCLUSIONS: Patients in the de-escalation group showed a significantly lower mortality rate compared to patients in the non-de-escalation group. De-escalation therapy can be safely provided to patients with ICU-acquired pneumonia if they are clinically stable by day 5, even in those whose respiratory specimen cultures yield no specific pathogens.
PMID: 21366903 [PubMed - as supplied by publisher]